Administering oral ketorolac prior to inserting an intrauterine device (IUD) is effective for reducing overall pain and pain during and after IUD insertion, according to findings from a double-blind, randomized controlled trial published in the Journal of Obstetrics and Gynaecology Canada.1
Patients from a community hospital who consented to be randomly assigned to receive 20 mg oral ketorolac (n=35) or placebo (n=36) approximately 40 to 60 minutes prior to having an IUD placed were included in the trial. Primary outcome for this study was subjective pain reduction during IUD placement as measured on a 0 to 10 scale.
Baseline characteristics of participants and providers were similar for both groups. In addition, no baseline differences were found in pain ratings before the procedures, at IUD placement with a tenaculum, or at uterine sounding.
Investigators noted a significant reduction of pain rating in the arm receiving ketorolac vs placebo at IUD insertion (4.2 vs 5.7, P =.031). The ratings for overall pain (3.6 vs 4.9, P =.047) as well as postprocedural pain at 10 minutes were also significantly lower in the ketorolac vs placebo group (3.6 vs 4.9, P =.047 and 1.1 vs 2.5, P =.007).
This study did not include one of the latest levonorgestrel-releasing (LNG) IUDs, which may limit the study’s findings to the T380A and LNG-IUS 52mg IUDs featured in this analysis. In addition, because this trial involved a small number of patients in one center, the results may not be generalizable to a larger group of patients.
Investigators of this study warn that ketorolac use is contraindicated in patients with liver disease, a history of peptic ulcer disease, advanced renal impairment, or recent gastrointestinal bleeding, warranting a thorough evaluation of medical “history is indicated before using this medication.”
- Crawford M, Davy S, Book N, Elliott JO, Arora A. Oral ketorolac for pain relief during intrauterine device insertion: a double-blinded randomized controlled trial [published online August 17, 2017]. J Obstet Gynaecol Can. doi: 10.1016/j.jogc.2017.05.014